Why bad news needs a plan
Some role-plays ask you to give serious news: a cancer diagnosis, a result that means a big change, a complication. These cards test Relationship building (empathy and respect under pressure) and Information giving (how you deliver, pause and check). On each, a B grade is usually around 2 out of 3 (approximate).
Several well-known frameworks for breaking bad news exist in medical training, and you may have learned one. You do not need to name or recite a framework in the test. What matters is what the assessor hears: that you prepared the person, told them clearly, gave them space to react, and helped them with what comes next. The staged approach below is our simple version.
Seven stages in plain words
- Set the scene. Introduce yourself, check who is present, and make sure it is a good time. "Is anyone with you today, or would you like someone here while we talk?"
- Find out what they know. "What's your understanding of why we did the test?" This tells you where to start and how worried they already are.
- Give a warning shot. One sentence that prepares them: "I'm afraid the results are not what we were hoping for." Then pause.
- Give the news simply. Use the real word, in plain English, in one or two short sentences. "The biopsy showed that the lump in your bowel is a cancer."
- Stop and respond to emotion. Silence is allowed. Let them speak first. Name what you see in their words: shock, fear, anger.
- Talk about next steps and support. Only when they are ready. Keep it general and hopeful where honest: who they will see, what happens next, who can support them.
- Check understanding and close. Ask what they have taken in, what questions they have, and make sure they know how to reach the team.
Weak vs better: the moment of the news
Doctor. A 60-year-old man has come for the results of a bowel biopsy.
So, your results came back and the histology shows adenocarcinoma of the sigmoid colon, so we'll be referring you to the colorectal surgeons for staging and possible resection.
I have your biopsy results here. I'm afraid it's not the news we were hoping for. [pause] The test showed that the growth in your bowel is a cancer. [pause] I'm so sorry. That's a lot to take in.
Why: The better version prepares him, uses the plain word, keeps it short, and stops. The weak version hides the news in jargon and rushes to treatment.
Responding to the reaction
After the news, the interlocutor may go quiet, cry, refuse to believe it or become angry. Your job is not to fix the feeling. It is to stay with it for a moment and show that you heard it. Then let them guide when to move on.
The test showed that the growth in your bowel is a cancer. I'm so sorry.
[silence] ... But I feel fine. I only came in because of a bit of blood.
I know. It's a real shock when you've been feeling well. [pause] What's going through your mind right now?
My wife. How am I going to tell her?
That's a big worry. You don't have to do it alone. We can talk about how to tell her, and she's welcome to come to the next appointment with you.
The doctor allows silence, names the shock, asks an open question and responds to the specific concern (his wife) before any treatment talk.
Phrase bank: breaking bad news
Is it all right if we talk about your results now?
Setting the scene and checking readiness.Would you like someone with you while we go through this?
Offering support before the news.What have you been told so far about why we did the scan?
Finding out what they know.I'm afraid the results aren't what we were hoping for.
Warning shot. Pause after it.The scan showed that the lump is a cancer.
The news itself: plain word, short sentence.I'm so sorry. Take all the time you need.
Straight after the news, then stay quiet.What's going through your mind right now?
Inviting the reaction after silence.It's completely normal to feel shocked.
Normalising the reaction.Would it help to talk about what happens next, or would you like a moment?
Letting the patient choose the pace.You won't be on your own with this. The team will support you at every step.
Support and next steps, without false promises.Can you tell me what you'll say to your family about today?
A gentle way to check understanding at the end.
What to avoid
| Avoid | Why | Instead |
|---|---|---|
| Medical jargon ("adenocarcinoma", "metastatic") | The patient may not realise they have heard bad news. | Plain words: "cancer", "it has spread to the liver". |
| False reassurance ("It'll be fine", "It's very treatable" before you know) | You cannot promise outcomes, and it can damage trust later. | Honest hope: "There are treatments, and the specialist team will talk you through them." |
| Rushing to treatment details | The person cannot take in information while in shock. | Pause, respond to emotion, ask before moving on. |
| Filling every silence | Silence gives time to absorb the news. | Count three seconds in your head before speaking. |
| Giving survival numbers in the role-play | You rarely have enough information on a card, and it is not usually the task. | Say the specialist team will discuss what it means for them. |
How it plays out across 5 minutes
- 0:00 to 0:45: opening, check who is present, find out what they know.
- 0:45 to 1:15: warning shot, the news in plain words, then stop.
- 1:15 to 3:00: respond to emotion and concerns. This is often the longest part.
- 3:00 to 4:30: next steps and support in two or three chunks, only if they are ready.
- 4:30 to 5:00: check understanding, questions, how to contact the team.
Check yourself
4 quick questions. Tap an answer to see why.
1 Which sentence is the best warning shot?
2 After you give the news, the patient goes silent. What is the best response?
3 Which response avoids false reassurance?
4 Why should you say the word "cancer" clearly at some point?